<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rh_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rh_date" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[opt_date]" type="text" value="{$row.opt_date}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[mobile]" type="text" value="{$row.mobile|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control" name="row[address]" type="text" value="{$row.address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-price" min="0" class="form-control" step="0.01" name="row[price]" type="number" value="{$row.price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-remark" class="form-control " rows="5" name="row[remark]" cols="50">{$row.remark|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text" value="{$row.phone|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Anzhuang_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-anzhuang_fee" min="0" class="form-control" step="0.01" name="row[anzhuang_fee]" type="number" value="{$row.anzhuang_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhaoshu')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhaoshu" class="form-control" name="row[zhaoshu]" type="text" value="{$row.zhaoshu|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Gonghao')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-gonghao" class="form-control" name="row[gonghao]" type="text" value="{$row.gonghao|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouli_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shouli_id" class="form-control " name="row[shouli_id]" type="text" value="{$row.shouli_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lanzhuang_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lanzhuang_id" class="form-control " name="row[lanzhuang_id]" type="text" value="{$row.lanzhuang_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Cardid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-cardid" class="form-control" name="row[cardid]" type="text" value="{$row.cardid|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ticheng')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ticheng" class="form-control" name="row[ticheng]" type="number" value="{$row.ticheng|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('底单')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-di_image" class="form-control" size="50" name="row[di_image]" type="text" value="{$row.di_image|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-di_image" class="btn btn-danger faupload" data-input-id="c-di_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="true" data-preview-id="p-di_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-di_image" class="btn btn-primary fachoose" data-input-id="c-di_image" data-mimetype="image/*" data-multiple="true"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-di_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-di_image"></ul>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
